Provider Demographics
NPI:1598737348
Name:SMITH, TRENT M
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WESTMINSTER HWY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1427
Mailing Address - Country:US
Mailing Address - Phone:864-647-2425
Mailing Address - Fax:864-647-2425
Practice Address - Street 1:101 WESTMINSTER HWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1427
Practice Address - Country:US
Practice Address - Phone:864-647-2425
Practice Address - Fax:864-647-2425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3617Medicaid